Utilization Management Nurse Consultant

CVS Health

Utilization Management Nurse Consultant at CVS Health reviewing clinical documents and coordinating care. Ensuring high-quality healthcare for members across the continuum with clinical guidelines.

Posted 7/13/2026full-timeRemote • Pennsylvania • 🇺🇸 United StatesJuniorMid-Level💰 $29 - $62 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in clinical documentation review and application of guidelines to support coverage decisions, while effectively collaborating with providers and care teams to enhance treatment outcomes and resource utilization.

Highest-signal resume keywords

Active RN LicenseAdult Acute Care ExperienceCritical Care ExperienceClinical JudgmentCommunication Skills

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Soft Skills

Multitasking Skills

Certifications & Qualifications

Active RN License

Industry Keywords

Clinical DocumentationCoverage DecisionsQuality ImprovementHolistic CareStakeholder Engagement

About the role

Key responsibilities & impact

Review clinical documentation and apply guidelines to support coverage decisions
Collaborate with providers and care teams to coordinate appropriate treatment
Identify opportunities to improve quality, outcomes, and resource utilization
Connect members to programs and services that support holistic care
Provide clinical expertise to internal and external stakeholders

Requirements

What you’ll need

Active, unrestricted RN license in your state of residence
2+ years of adult acute care or critical care experience
Strong clinical judgment, communication, and multitasking skills
Comfort working in a fast-paced, technology-driven environment

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs